Abstract

Kenya has developed a model of the Bamako Initiative which differs in some respects to that developed in other African countries. It has established a system of community pharmacies in peripheral areas which acts as the locus of a community financing programme, focused on the provision of drugs and disease control activities carried out by Community Health Workers. This model addresses problems of geographical accessibility rather than quality in existing services. While it responds to the most urgent health service problems in Kenya, it ignores the communities felt needs for the extension of services to treat serious illnesses. Nevertheless, the Initiative has been successful in generating community enthusiasm and in establishing an affordable and sustainable services. It is important that the Bamako Initiative is not marginalized from the main health service delivery system and is not seen as a substitute for extension of services. In the longer term, the Initiative should be used to support efforts to strengthen quality and improve accessibility at higher levels.